Keeping our bones strong is essential to our overall health and quality of life.  Throughout life we constantly lose old bone and form new bone, reaching our peak bone mass between the age of 25 and 35. But after age 35, women tend to lose bone, a loss that accelerates after menopause. Women can lose up to 20 percent of their bone density in the five  to seven years after menopause. Therefore, it is important to protect our bones and keep them healthy by maintaining a balanced diet rich in calcium and vitamin D.

Calcium is the building block for bones. Calcium is found in milk, leafy green vegetables, soybeans and foods fortified with calcium. Over the age of 50, the US RDA is 1200-1500 mg per day. Some great ways to meet these recommendations is eating a well balanced diet rich in calcium. One cup of skim milk=300 mg, one cup of plain yogurt=400 mg, one cup of broccoli=72 mg, one cup of spinach=150 mg and one cup vanilla frozen yogurt (soft serve)=205 mg. For more information on calcium rich foods, visit http://www.whfoods.com/genpage.php?tname=nutrient&dbid=45

Vitamin D is essential for the absorption of calcium. Most vitamin D comes from the sun. However for those of us who live above the Mason-Dixon line, we may not be getting enough sunlight, especially during the winter months. Thirty minutes of sun provides from 10,000-12,000 IU of vitamin D. Vitamin D is found naturally in a few foods such as salmon, mackerel, canned tuna,  sardines and eggs. Many foods are fortified with vitamin D, including milk and breakfast cereals.

Taking calcium with vitamin D can provide a nice supplement to your dietary intake. It is important to take the calcium and vitamin D with food to promote absorption, and if taking 1200 mg of calcium daily, it should be taken in two divided doses to maximize effectiveness.  Also important to remember, if you are taking thyroid medication, synthroid and calcium supplements should be seperated by four hours.

Strong bones support us, provide the framework for our muscles and allow us to move. Our bones are a storehouse for vital minerals, they protect our heart, lungs, brain and other vital organs. It is important to take care of our bones, so they can continue to take care of us.

written by Suzanne Mahoney, FNP-BC

In the most recent issue of Obstetrics & Gynecology, Jan Shifren and Isaac Schiff reviewed the literature about the use of hormone therapy (HT) in the menopause. The principle indication for hormone therapy remains the treatment of hot flushes and night sweats. Benefits generally outweigh the risks for healthy women with bothersome symptoms who elect to HT at the time of menopause. Although hormone therapy increases the risk of coronary heart disease, recent analyses confirm that this increased risk occurs primarily in older women and those a number of years beyond menopause. These findings do not support a role for HT in the prevention of heart disease but provide reassurance regarding the safety of use for hot flushes and night sweats in otherwise healthy women at this difficult time of life. An increased risk of breast cancer with extended use is another reason short-term  treatment is advised.

Hormone therapy prevents and treats osteoporosis but is rarely used solely for this indication. Estrogen is as effective as the other treatments for osteoporosis, so most women using HT for menopausal symptoms will not need additional treatment for their bones except for adequate calcium and vitamin D intake. If only vaginal symptoms are present, low-dose local estrogen therapy is preferred. There are creams, pills, and an estrogen ring which can be used to treat vaginal symptoms. They are all equally effective and which is used may be based on the woman’s preference. The risk profile for vaginal therapy is very different from systemic therapies, and there is no data that suggests a link between use of vaginal estrogen and the development of breast cancer or heart disease. There are safety studies up to 1 year showing no adverse endometrial effects, but studies of long-term effects of low-dose vaginal estrogen therapy are lacking. Therefore, women using vaginal estrogen therapy should report any vaginal bleeding and should undergo thorough evaluation.

Contraindications to HT use include breast or endometrial cancer, cardiovascular disease, history of blood clots, and active liver disease. Alternatives to HT is advised for women with or at increased risk for these conditions. The lowest effective estrogen dose should be used for the shortest duration necessary. Women should be informed of the potential benefits as well as the risks of all therapeutic options. Care should be individualized, based on a woman’s medical history, needs, and preferences.

written by Charla Blacker, MD

  Julie has a BFA in dance from the University of Michigan and has been teaching creative movement and ballroom dancing since 1977.  She completed her yoga teacher training and began teaching in 2000.  She has taught a wide variety of classes in the community for all age groups and continues to teach classes at West Bloomfield Parks and Recreation.  In 2008, she completed training in a yoga therapeutic program, “Yoga of the Heart,” based on Dr. Dean Ornish’s study on reversing heart disease.   She feels proud and fortunate to be an employee at Henry Ford Vita Wellness Center, teaching yoga classes which focus on the health benefits of yoga. In addition to the daily yoga classes, she also teachs Zumba, Ballet Stretch and Tone and Dance Your Way to Fitness.  She recently answered my questions about how Yoga may benefit women during menopause and beyond.

 I know you teach a Yoga for Wellness class now and have offered a Yoga for Menopause class in the past.  What prompted your interest in yoga and specifically yoga for menopause?

When I began my first yoga classes in 1995, I truly had little understanding of yoga.  I was recovering from a dance injury and thought yoga would be a good way to stay in shape while I was recovering.  I quickly recognized that yoga was as much about the body as it was about the mind.  In short order I began to notice the many benefits from practicing yoga.  I was inspired from my earliest classes to become a yoga teacher, guiding others to discover the benefits. The overall benefits of yoga, which include stress reduction, improved focus, mood regulation, improved sleep as well as strength, balance and flexibility have served me well as I have made the transition through menopause.  

 Yoga is well known for its benefits in managing stress.  How is it specifically helpful for menopausal symptoms?

 What  are the other health benefits of Yoga for women as they age ?

Is Yoga safe for everyone?  Are there any precautions women need to be aware of?

How would you recommend someone get started with Yoga?  Do you have any good resources you can share?

written by Deborah McBain, CNM MSN

Seems I’m hearing a lot more about the importance of Vitamin D in the last few years.  And this time of year as the days shorten and sunshine becomes a rare treat, it is timely vitamin to address.  We have long understood the link between Vitamin D and bone health.  Those of you who remember the practice of giving cod liver oil to children  to prevent rickets are witness to this old-time knowledge.  Cod liver oil is an excellent source of nutritional vitamin D.  Since vitamin D is known to help absorption of calcium, menopausal women often are advised to take it with calcium  to help prevent osteoporosis.  Studies now suggest that Vitamin D does a whole lot more than effect the bones.  Low vitamin D levels during pregnancy are being linked to more preeclampsia, low birth weight and premature labor.  Low vitamin D levels in childhood are now being linked to development of  asthma, diabetes and high blood pressure in later years.     A recent study published in the Journal of Nutrition suggests that women with vitamin D deficiencies may have more bacterial vaginosis, a common vaginal infection.  Other research links low vitamin D  levels to higher rates of colon and breast cancer, depression, diabetes, heart disease,  weight gain and chronic pain. Wow!

Chances are that if you live in Michigan you are vitamin D deficientor at least insufficient.  Your risk is even greater if you are older, dark skinned or cover your skin while outside.  Experts in the medical community generally agree that vitamin D deficiency among women is widespread.  Some predict that as many as  70% of white people and 97% of black people are deficient.   Vitamin D is either synthesized in the skin through exposure to ultraviolet B rays in sunlight or ingested as dietary vitamin D.  However it is difficult for humans to get adequate vitamin D from diet alone.  And our Michigan climate and latitude make it difficult to get enough sun exposure.  Then there is the dilemma of increasing the risk of  skin cancer with sun exposure.  Sun screen blocks the skins ability to synthesize Vitamin D.  What is a person to do?

Get your vitamin D level checked.  Ask your health care provider about getting this simple blood test the next time you go for an exam.

Consider taking a supplement.  There is no general agreement about the optimal intake of vitamin D. Some researchers say the current recommended intake of 400 international units (IU) to 600 IU daily is inadequate and suggest a much higher daily intake, from 1,000 IU to 5000 IU.  Cholecalciferol is the preferred form.   It is easily available in any drug store and not terribly expensive. If your blood levels are low your health care provider may give you with a high dose prescription form of vitamin D.  Experts reassure that it is rare and dificult to get too much Vitamin D but check with your care provider.

Include nutritional sources of Vitamin D in your diet.  Look for vitamin D fortified foods such as milk,cereals, orange juice and yogurt.  Other foods with vitamin D include tuna, salmon, beef liver, egg yolks, cheese. ( and of course cod liver oil if you can stomach it)

Continue limited sun  exposure.  (if you can find it!)  Most experts say that 15-30 minutes of sun exposure without sunscreen is reasonably safe.  Getting this amount most days of the week can help boost most peoples vitamin D levels safely.

written by Deborah McBain, CNM MSN

An almost inevitable consequence of menopause is thinning bones.  And why is that important?  Because if bones get too thin they break.  Broken bones lead to even more serious problems.  Thin bones, also known as osteoporosis can cause any bone to break particularly with a fall, but the most common bones to fracture are vertebrae, hip and wrist. 

 BONES ARE IMPORTANT BECAUSE… Almost 300,000 Americans over 45 are admitted to the hospital with hip fractures each year.  Osteoporosis was the underlying cause for most of these injuries.  An average of 24% of hip fracture patients over 50 will die in the year following their fracture.  Of those who were ambulatory before their hip fracture, 20% will require long term care after.  Six months after a fracture only 15% will be able to walk across a room unaided.  Ten million people in the U.S. have osteoporosis and 80% of those are women.  Another thirty four million have low bone mass putting them at risk for osteoporosis.  Costs of osteoporosis fractures are  about $20 billion dollars a year and are expected to rise to over $25 billion by 2025.

KNOW YOUR RISKS…Asian and Caucasian women are at greatest risk.  But significant risk has been reported in all ethnic backgrounds.  Ten percent of Hispanic women have osteoporosis and 49%  have low bone mass.  Five percent of African-American women have osteoporosis and another 35% have low bone mass.   Other risk factors include: family history; poor diet low in calcium and Vitamin D, excess intake of protein,sodium and caffeine; lack of exercise, smoking; excess alcohol;certain medications such as steroids and anticonvulsants; certain diseases such as rheumatoid arthritis, anorexia nervosa, gastrointestinal diseases.

KNOW WHAT TO DO TO DIAGNOSE…  If you are over 60 or have other risk factors ask your care provider about getting  a bone mineral density test (BMD).  Most experts recommend  a type of BMD called a DXA scan.  This scan can tell if you have osteoporosis or low bone mass and help predict the chances of fracture in the future.  This will guide you and your health care provider in the decision about  need for treatment.   Medications can help halt the progress and even reverse osteoporosis reducing the chance of fracture. 

KNOW WHAT TO DO FOR PREVENTION…Tell your daughters, granddaughters, neices to drink their milk!  About 85-90% of bone mass is acquired by age 18 in girls.  Building strong bones early helps prevent osteoporosis later.  Get enough calcium and vitamin D.   Calcium 1200-1500 mg per day for those over 50 years old.  Many experts are now recommending  at least 1000 IU of Vitamin D per day.  Avoid smoking and alcohol.  Weight bearing exercises have been shown to reduce loss of bone density.  Strength building exercises reduce risk of falling and therefore fracture risk.

KNOW WHERE TO GO FOR MORE INFORMATION… A couple good web sites are:  www.nof.org (National Osteoporosis Foundation)  for more information on osteoporosis and www.strongwomen.com  for information on exercise.

written by Deborah McBain, CNM MSN